title: Hematoma volume affects the accuracy of computed tomographic angiography 'spot sign' in predicting hematoma expansion after acute intracerebral hemorrhage.
abstract: BACKGROUND
  We hypothesized that the presence of tiny, enhancing foci ('spot sign') within acute hematomas is associated with hematoma expansion.
  
  
  METHODS
  We retrospectively analyzed the effect of hematoma volume on accuracy of computed tomographic angiography (CTA) in predicting hematoma expansion in 312 patients with acute intracerebral hemorrhage (ICH). The patients were divided into 2 groups according to their initial hematoma volume (<30 vs. ≥30 ml). CTA was performed at admission and 24 h after initial presentation.
  
  
  RESULTS
  The <30-ml group consisted of 203 patients of whom 42 had hematoma expansion (20.9%). The ≥30-ml group consisted of 109 patients of whom 34 had hematoma expansion (31.19%). In the <30-ml group, the sensitivity and specificity of CTA in predicting hematoma expansion were 71.4 and 93.8%, respectively. In the ≥30-ml group, the sensitivity and specificity of CTA were 85.7 and 91.9%, respectively. For all 312 patients, the area under the curve was 0.86 (p < 0.001, 95% CI 0.80-0.92); the sensitivity and specificity of CTA were 77.9 and 93.2%, respectively.
  
  
  CONCLUSIONS
  CTA can reliably predict hematoma expansion in clinical practice, especially for hematomas >30 ml.
authors.affiliation: Department of Neurosurgery, First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China. yhwang1973@yahoo.com.cn
authors.forename: Yue-Hua
authors.initials: YH
authors.lastname: Wang
authors.forename: Jin-Yu
authors.initials: JY
authors.lastname: Fan
authors.forename: Guang-Dong
authors.initials: GD
authors.lastname: Luo
authors.forename: Tie
authors.initials: T
authors.lastname: Lin
authors.forename: De-Xuan
authors.initials: DX
authors.lastname: Xie
authors.forename: Feng-Ying
authors.initials: FY
authors.lastname: Ji
authors.forename: Xiang-Tong
authors.initials: XT
authors.lastname: Zhang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002533:Cerebral Angiography; D002540:Cerebral Cortex / Q000000981:diagnostic imaging*; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging*; D005260:Female; D006406:Hematoma / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012680:Sensitivity and Specificity